Live from the APA - Neurobiology, DBSA, and Country Cures

John McManamy Health Guide
  • It's 5 PM and I'm about to call it a day. I'm in Washington DC at the American Psychiatric Association's annual meeting. Yesterday, I picked up my media credentials, got the lay of the land, then went back to my hotel. I had circled in a breakfast symposium that I was planning on not waking up on time for, but no such luck.  At 5 AM my eyes popped wide open, and, despite my best efforts refused to close.

     

    Breakfast features extra-generous portions of grease, which explains the swimming pool water in my glass. Nothing like chlorine to cleanse the palette. A psychiatrist to my right informs me that in Canada, bipolar is diagnosed far less in kids than it is in the US.

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    Then Joe Biederman's group from Harvard walks us through the fine points of the neurobiology of bipolar and ADHD. Thanks to neuro-imaging, the findings are coming in thick and fast. Through brain scans, researchers compare both brain structure and brain function between mentally ill patients and healthy subjects.

     

    We now know that even though bipolar and ADHD may manifest in similar ways, particularly in kids, they are essentially diseases of two different parts of the brain. It is helpful to think of bipolar as a disease of the limbic system (the primitive region of the brain involved in processing emotion) while ADHD affects certain parts of the brain associated with cognition - in particular an area known as the anterior cingulate that has to do with "executive control."

     

    Noon finds me at a DBSA luncheon. The event is hosted by the organization's Scientific Advisory Board, and the research heavyweights are out in force - Thomas Insel, director of the NIMH, Hussein Manji, chief of the Mood Disorder Unit at the NIMH whose work has literally opened up a new branch of brain science, David Kupfer, chair of the DSM-V task force, Gary Sachs, who headed up the NIMH's STEP-BD real world clinical trials, legendary epidemiologist Myrna Weissman, Kay Jamison. The list goes on and on.

     

    I have my camcorder with me, and succeed in procuring several quickie interviews. On the bus from the hotel venue back to the convention center, I converse with Robert Post of the NIMH. Dr Post is the originator of the kindling hypothesis in bipolar and in waking psychiatry up to the fact that our population is depressed way more than manic, plus many more accomplishments. On the bus, he graciously answers my questions about how to best interpret clinical trial data.

     

    Back at the convention center, I visit the exhibit hall. The pharmaceutical industry with their mega-displays dominate, but I manage to find two doctors staffing a small table representing an organization called "No Free Lunch." Their point is that industry largesse compromises clinical judgment at the expense of the patient. One of the doctors consents to being interviewed on camera. I now have a fairly good collection of clips "in the can," provided that I haven't done something stupid like leave the lens cap on.

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    I manage to find the Gould Farm booth just as the Exhibit Hall is to shut down for the day. The woman manning the booth is scooping up her brochures when I greet her.

     

    Gould Farm in the Berkshires is based on the old-fashioned and now cutting edge principle that a work setting in the country, with a full range of clinical and rehabilitative services, can work wonders. The original institutions from the 1830-1840s were built on that enlightened principle. Originally these institutions had farms attached to them, and recovery rates were fairly high. Only later did these places deteriorate into unspeakable snake pits.

     

    The day before, after registering, I had fortuitously come across an exhibit of vintage postcards of the old institutions and spas. Palatial buildings, country settings. My camcorder roamed Ken Burn style over the display.

     

    Now the clinical director of Gould Farm and I are animatedly talking. I will definitely be paying a visit on my next east coast trip.

     

    Tomorrow, it's a full day of solid brain science. Exciting discoveries are pointing the way to a new generation of meds, but they are also validating the venerable philosophy of Gould Farm. Smart meets humane.

     

    Time to wind down ... 

     

     

Published On: May 05, 2008